Sudden death of mom raises questions about rehab center

Jul. 17, 2011

Lindsey Poteet was at New Life Lodge to kick her drug addiction and make a better life for daughter Arwen. / SUBMITTED PHOTO

Written by

About New Life Lodge

Beginnings: New Life Lodge opened in 1983 to serve as a rehabilitation center for Tennesseans battling addiction to drugs and alcohol.

Owners: CRC Health, a private company based in California, purchased the nonprofit operation in 2006. The facility underwent a $10 million renovation and expansion project, which was completed earlier this month.

Safety: New Life Lodge executives say the facility has had only one patient death in its 27-year history, but public documents bring that claim into question.

More

ADVERTISEMENT

'Tennessean' Investigation

For Lindsey Poteet, Sept. 1, 2010, was supposed to be the day she finished a monthlong drug rehabilitation program, giving her a fresh start to care for her 17-month-old daughter, Arwen.

Instead she lay brain-dead and on life support in a Nashville hospital bed.

The 29-year-old had checked into New Life Lodge, a residential drug rehab facility in the secluded town of Burns in Dickson County, in early August, but within weeks became very ill.

The circumstances of her death have brought an array of unanswered questions from her family and shined a spotlight on the oversight of the largest drug rehabilitation facility in the state that is also one of the largest providers of state-subsidized care and rehabilitation for drug and alcohol addicts. It treats adults and youths.

Why was Poteet, who had come down with pneumonia, placed in a van and driven 30 miles to Nashville when Horizon Medical Center was just 8 miles from the rehab center? Why was the van driven by a woman who didn’t know how to discern during a 911 call if Poteet was breathing or not?

Why did it take so long to get Poteet the proper medical help when she was at a health facility that specializes in helping people like her recover? Poteet’s autopsy said she died of combined drug toxicity, a mix of anti-depressant and therapeutic drugs. It was ruled accidental.

Amerigroup, the TennCare insurance company paying for Poteet’s treatment, conducted a review of New Life Lodge after her death. A TennCare spokeswoman said Amerigroup is no longer contracting with New Life to handle patients but couldn’t say why.

A months-long investigation of New Life Lodge by The Tennessean uncovered deaths of patients in 2010, but just how many is unclear in conflicting accounts that New Life Lodge declines to clarify, citing patient privacy protections.

For example, state officials say that two deaths at New Life Lodge were reported to them in 2010 by the facility’s executive director, who later told The Tennessean that only one patient had died in New Life Lodge’s history.

The date of Poteet’s death does not match the dates on the state reports, raising the possibility that there were three deaths in one year.

The Tennessean investigation also found:

The state in 2008 vastly reduced oversight of residential treatment facilities such as New Life, eliminating pages of regulations. And because of cost, the Department of Mental Health stopped doing its own health-care quality inspections of these facilities, instead relying on a private accrediting agency. The result has been that details that might bring greater understanding of a facility’s health-care record are kept secret.

The medical license of the new head physician hired in 2011 at New Life Lodge has been on a five-year probation since May 2010 after he failed a drug test at his previous employer and had admitted his own addiction to street drugs, according to public records. He retains the right to practice medicine.

At least four New Life Lodge staffers operate halfway houses as side businesses. According to former co-workers, the staffers sometimes steer New Life Lodge patients to their own facilities.

Patients have at times dealt with overcrowding, sleeping on couches, and former employees have cited strained working conditions, such as being asked to conduct tasks for which they were not trained.

New Life Lodge Executive Director Rebecca Gaskin said her facility provides a crucial service to Tennesseans by offering residential rehabilitation services, while also operating a detoxification center. In a recent news release touting the facility’s $10 million renovation, New Life Lodge said 92 percent of its patients completed treatment.

Between TennCare and state contracts with the Department of Mental Health and the Department of Children’s Services, New Life Lodge benefits from about $10 million annually in government funding, according to public records. The facility is owned by California-based CRC Health, which bought the operation for $3.8 million in 2006. CRC itself was bought the same year for $720 million by Bain Capital.

Though she declined to discuss details surrounding Poteet’s death because of patient confidentiality laws, Gaskin said the event was a traumatic one for the facility’s staffers.

“It was horrifying, and it was sad, and it was heartbreaking,” Gaskin said. “And there’s not a one of us who survived that who did not walk away in a different place. It was personal for us. It still is.”

Poteet’s mother, Kathy Mauk, said, however, that her biggest questions about her daughter’s death have never been answered.

In the days leading up to her death, Poteet phoned family members several times. During those conversations, Poteet had a heavy cough, had difficulty breathing and could barely talk, according to her mother. A friend of Poteet also said she was very ill.

A 911 call on Aug. 31 and conversations with people at New Life Lodge describe what happened that morning when critical decisions were made to get Poteet to a hospital.

So weak she could not walk on her own, Poteet was placed in a van to be taken to Saint Thomas Hospital in Nashville. Dr. Jonathan Butler, New Life Lodge’s physician at the time, called Saint Thomas to alert them of Poteet’s arrival.

En route, she became unresponsive and the van’s driver called 911. During the call, the dispatcher asked if the driver could tell if Poteet was breathing or not.

“How would I do that? I’m not a nurse. I’m not sure,” the driver responded, before being asked by the dispatcher if Poteet’s chest was rising. “No I don’t see it.”

Butler, who no longer works for New Life, did not respond to a detailed request for comment.

Mauk said she has not been told why her daughter was transferred by a van to Nashville instead of an ambulance to the nearby hospital.

“I’m still confused about why she was transferred by private vehicle,” Mauk said. “Why she died in the back of a van. Why she wasn’t given treatment sooner. And why I was given the runaround by the place that let it all happen.”

An autopsy report conducted by the state medical examiner showed that Poteet had severely congested lungs and pneumonia. The autopsy also revealed she had heart surgery years earlier to repair her mitral valve.

But according to the autopsy, neither the pneumonia nor the heart surgery caused her death, but rather a combined drug toxicity. Poteet had elevated levels of the anti-depressant drug citalopram and therapeutic levels of trazodone. Poteet’s death was ruled an accident by medical examiner Dr. John Brentley Davis.

Gaskin said New Life Lodge acted as soon as possible once it realized Poteet was ill.

“We do know that, once the patient began showing signs of distress, our staff immediately took action to get her the professional help she needed,” she said.

Records indicate other deaths among patients

Public records indicate Poteet was not the only patient at New Life Lodge to pass away in 2010. According to the Department of Mental Health’s response to a public records request, Gaskin reported two deaths in 2010 — on July 16 and Aug. 21. No deaths were reported on the date Poteet died, according to Department of Mental Health spokesman Grant Lawrence.

Records from 911 calls and interviews with the Burns Fire Department show that New Life Lodge requested emergency assistance on the eves of the two reported deaths.

On July 15, the fire department and the Dickson County ambulance service responded to a call from a New Life Lodge nurse about a male patient in his mid-20s in the detox unit who was not breathing and unresponsive.

Burns Fire Capt. Brannon Wilkerson, who responded to the scene, told The Tennessean the patient ultimately passed away at Horizon Medical Center. The patient who died was on TennCare, according to department spokeswoman Kelly Gunderson.

Records from a 911 call by a New Life Lodge nurse on Aug. 20 indicate a patient in the detox unit suffered multiple seizures and was unresponsive. Because of claims of patient confidentiality law, The Tennessean could not confirm the patient’s identity or whether that person ultimately died. New Life Lodge would not comment on whether the call was related to a patient who died.

Officials with Dickson County Emergency Medical Service and the Burns Fire Department said they could not reveal the identities of the individuals named in their reports, stating patient confidentiality laws prevented it.

When confronted with the state’s records of two deaths, Gaskin insisted that the facility had only one patient death in its nearly 30-year history.

“In addition, it seems necessary to reiterate that just because a facility informs (the department) of an incident does not mean the incident took place on facility grounds or as a result of any action taken by, or fault of the facility,” Gaskin said.

Nonetheless, state officials said no New Life deaths were reported on Sept. 1, which is the date Poteet passed away. In an interview with The Tennessean, Gaskin referred to Poteet’s death without saying her name.

“Like for example, the August situation with the Amerigroup patient, she was a New Life Lodge patient. Clearly she deceased, she was in our care,” Gaskin said.

Cynthia Tyler, who is the Department of Mental Health’s director of the Office of Licensure, said it would be a violation of state regulations for New Life Lodge to fail to report a patient death. Gaskin said New Life has followed all state regulations in reporting deaths.

Overcrowding described

Interviews with former New Life Lodge patients, staffers and public officials from Dickson County indicate other concerns with the rambling facility that sits on 120 wooded acres.

Between its adult program, youth program and detox center, New Life Lodge is licensed to house 228 people. The next-largest facility in the state, Nashville’s Cumberland Heights, has a capacity of 130.

According to the Dickson County Sheriff’s Office, deputies responded to 178 calls for service in 2010, many of them for runaway youths. Cumberland Heights by comparison had 28 calls for service, according to the Metro police department.

Dickson County Sheriff Jeff Bledsoe said in a recent interview he wanted to discuss with New Life Lodge leadership his issues with the facility’s operations. The primary issue, Bledsoe said, is the time and resources his deputies devote to calls from the facility. A spokesman for the Burns Fire Department said it is not uncommon for there to be four calls for emergency service during a 24-hour shift.

“We have some concerns,” Bledsoe said. “I’ve been talking to some of the administrative staff when I took office about sitting down and discussing the issues and seeing how we can work together to address the problems they do have.”

According to Malea Stevens of Murfreesboro, who became friends with Poteet shortly before her death, the facility was sometimes so overcrowded that patients were sleeping on the floor and on couches.

“They had three or four people in a room and there were people sleeping on cots and sofas. There were supposed to only be 60 or 70 people, but they had over 100.”

Stevens said that in the days leading up to Poteet’s death, she had become sicker and weaker and had to be carried the night before to a couch, where she spent the night.

“She was very sick,” Stevens said.

Gaskin dismissed complaints of overcrowding and said any issues had been remedied by the recent renovation, which doubled dormitory housing to 200 beds.

Michael Casey worked as a technician at New Life Lodge for nearly a year in 2010. Casey said he was sometimes asked to perform tasks outside of his training, such as administering medication and posing questions typically asked by a professional counselor.

“They were having me do casework. I felt very uncomfortable,” Casey said, adding that he believed other staff also were asked to perform tasks outside their training. “It was crazy.”

Addict hired as doctor

Earlier this year, New Life Lodge hired Dr. Kevin Collen as its primary physician, even though Collen had recently completed a drug rehab program in Alabama.

After failing a drug test conducted on Jan. 21, 2010, by his previous employer, Nashville-based Mental Health Cooperative, Collen admitted that he had an addiction to street-level methamphetamine and benzodiazepines for more than one year, according to records maintained by the Tennessee Department of Health.

Collen was fined $5,000, and his medical license was placed on a five-year probation.

Gaskin said she viewed Collen’s addiction struggles as an attribute and said his medical license has no restrictions.

“Dr. Collen is in recovery with monitoring, an attribute that proves invaluable when helping patients overcome their own addictions,” Gaskin said. “After all, ours is a business of rehabilitation, redemption and second chances.”

Casey, the former staffer, said he also was troubled by the fact that four New Life Lodge employees make money on the side by working for or operating their own halfway houses. A halfway house is a transitional living facility where recovering addicts sometimes live before they can find permanent housing.

Casey and other former New Life employees said the staffers sometimes refer New Life Lodge patients to their halfway houses after their stay at the rehab facility is complete. Gaskin denied that claim and said patients are provided with a list of potential halfway houses and are free to make their own selection.

The four New Life Lodge employees could not be reached or declined to comment.

“None of (the staffers) are able to refer patients,” Gaskin said. “And to tell you the truth, I couldn’t tell you which staff have halfway houses because, since I’ve dropped into Tennessee, it seems like that’s a common practice. But none of that staff that you mentioned have any ability to refer patients any place.”

Casey said he believed New Life Lodge was staffed with people who genuinely wanted to help others overcome their addiction. The problem, he said, was the for-profit facility’s fixation on the number of patients.

“New Life is helping people… but it’s all about the numbers,” Casey said.

As the one-year anniversary of her daughter’s death approaches, Mauk said she feels New Life Lodge failed its top mission. The family is preparing a lawsuit against the facility.

“I’m overwhelmed and broken-hearted. No mother should ever have to turn off her 29-year-old daughter’s life support because there is no hope. There are no words to describe how that feels.

“People are supposed to be safe in medical facilities,” Mauk said. “I had no idea from talking with (a nurse at New Life Lodge) how bad it was. Of course I wanted answers, but no one at New Life Lodge would give us any. I’m not getting the chance to be with Lindsey once she got her life turned around.”